Tuberculosis from transmission in clinics in high HIV settings may be far higher than contact data suggest
Tuberculosis from transmission in clinics in high HIV settings may be far higher than contact data suggest
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DOI：
10.5588/ijtld.19.0410
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发表时间：
2020-04-01
影响因子：
4
通讯作者：
White, R. G.
中科院分区：
文献类型：
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作者：
McCreesh, N.;Grant, A. D.;White, R. G.
背景：在南非，一般估计只有 0.5-0.6% 的人接触发生在诊所。然而，传染性结核病患者和疾病进展易感性较高的人可能会在诊所花费更多时间，这增加了临床传播对总体疾病发病率的重要性。 方法：我们开发了一个说明性的结核分枝杆菌在诊所和其他环境中传播的数学模型。我们假设 1% 的接触时间发生在诊所。我们改变了人类免疫缺陷病毒 (HIV) 阳性者与 HIV 阴性者的诊所接触时间比率，以及传染性结核病患者与非结核病患者的比率，同时保持诊所接触时间的总体比例以及每个人的总接触时间不变。 结果：HIV 阳性者和结核病患者的诊所接触率分别高出 10 倍和 5 倍，为 10.7%（合理范围） 8.5-13.4%的结核病是由诊所传播造成的。 HIV 阳性人群和结核病患者的接触率分别高出 5 倍和 2 倍，所有结核病的 5.3%（合理范围为 4.3-6.3%）是由于诊所传播所致。结论：诊所中通常发生的少量接触时间可能会大大低估其在高 TB-HIV 负担环境中对结核病的影响。
BACKGROUND: In South Africa, it is generally estimated that only 0.5-0.6% of people's contacts occur in clinics. Both people with infectious tuberculosis and people with increased susceptibility to disease progression may spend more time in clinics, however, increasing the importance of clinic-based transmission to overall disease incidence.METHODS: We developed an illustrative mathematical model of Mycobacterium tuberculosis transmission in clinics and other settings. We assumed that 1 % of contact time occurs in clinics. We varied the ratio of clinic contact time of human immunodeficiency virus (HIV) positive people compared to HIV-negative people, and of people with infectious TB compared to people without TB, while keeping the overall proportion of contact time occurring in clinics, and each person's total contact time, constant.RESULTS: With clinic contact rates respectively 10 and 5 times higher in HIV-positive people and people with TB, 10.7% (plausible range 8.5-13.4%) of TB resulted from transmission in clinics. With contact rates in HIV-positive people and people with TB respectively 5 and 2 times higher, 5.3% (plausible range 4.3-6.3%) of all TB was due to transmission in clinics.CONCLUSION: The small amount of contact time that generally occurs in clinics may greatly underestimate their contribution to TB disease in high TB-HIV burden settings.